Dietary supplements marketed as aids for weight loss, sports performance, and other uses have been linked to serious health problems in young people, according to a study published today in the Journal of Adolescent Health. The Pew Charitable Trusts spoke with the study’s senior author, S. Bryn Austin, director of fellowship research training in the Division of Adolescent and Young Adult Medicine at Boston Children’s Hospital and director of the Strategic Training Initiative for the Prevention of Eating Disorders based at Harvard University’s T.H. Chan School of Public Health and Boston Children’s Hospital.
This interview has been edited for clarity and length. Opinions expressed by Austin are her own and do not necessarily reflect those of Pew.
Q: What are some of the study’s key findings on serious adverse events in youth?
A: Working with 11 years of data from the Food and Drug Administration’s adverse events reporting system on dietary supplements, we found certain types of supplements are quite dangerous for children and young adults. Dietary supplements sold for weight loss, sports performance, or energy are three times more likely than vitamins to cause severe medical consequences for a young person, including loss of consciousness, disability, and even death. Supplements sold for sexual function and so-called colon cleanse are two times more likely than vitamins to be linked with severe medical consequences in young people.
Q: How does this study fit into the body of knowledge about the potential safety hazards of these products, particularly by young people and people with eating disorders?
A: We’ve known for a long time that some dietary supplements, especially those sold for weight loss, sports performance, and energy, are linked with serious health harms, such as liver injury, strokes, testicular cancer, and more. A mountain of research has documented time and again manufacturers’ adulteration of these products with dangerous ingredients, including banned pharmaceuticals, steroids, liver toxins, and more. What we haven’t known until now is how these risky products are affecting young people.
Q: What do we know about patterns of usage of supplements marketed for weight loss or muscle building by young people and people with eating disorders?
A: Roughly a third of teens use dietary supplements of any type, the majority being vitamins. But a growing proportion are using weight loss, sports performance, and energy supplements as those sectors of the market expand their consumer base nationally and internationally. We’re especially concerned about young people with eating disorders, struggles with body image, or other mental health problems, because they’re more likely to be most vulnerable to manufacturers’ deceptive claims that these products will help lose belly fat or build bulging muscles. Studies with adults have found the majority mistakenly believe that dietary supplements are prescreened for safety and efficacy by the government before they’re put on store shelves. If most adults are this misinformed, how can we expect children and young people to be more savvy consumers of supplements?
Q: You’ve spent your career studying eating disorder prevention and health inequity. What sparked your interest in supplements?
A: I’ve worked in the fields of eating disorders prevention and public health for 20 years now. In my early years, psychologists, sociologists, and feminist scholars were doing a great job of documenting how our culture has essentially been teaching girls that their appearance and thinness were virtues above all else and that they should use any means necessary to achieve societal standards of beauty and thinness, no matter the costs to their physical or mental health. In parallel with that research, another stream of dedicated scholars was building the evidence base for preventive interventions for eating disorders, chiefly designing school-based interventions to help kids become more resilient in the face of this toxic environment.
This was all excellent research, but I had a nagging feeling that something was missing. There was no meaningful or sustained dialogue between public health professionals and eating disorder specialists. I was the odd one out in my public health school and among my colleagues by bringing the two fields together, but I couldn’t quite put my finger on what was missing.
Then about a decade into my career, it finally dawned on me: The No. 1 negative consequence of this disjuncture between public health and eating disorders prevention was that almost all prevention strategies were individually targeted interventions. Despite all the research showing how detrimental the environment related to body image and dieting was on young people, there was almost no research on how to change that environment.
It was as if we were still doing only school-based interventions to help kids resist cigarettes and had never introduced any efforts to restrict sales, curtail advertising, or tax or ban tobacco products. So I decided to develop strategies for chipping away at the macro-level forces contributing to eating disorders and related problems with disordered weight-control behaviors and body image.
Why the focus on dietary supplements in particular? Well, on the U.S. market now, all but one of the over-the-counter pills or powders promising weight loss to consumers are marketed as dietary supplements. At the same time, no reputable physicians recommend that people use these products to lose or maintain weight. In fact, the American Academy of Pediatrics came out with a report a couple of years ago making clear that providers should discourage youth from ever using these products, regardless of their weight. We don’t sell tobacco to kids. So why sell them diet pills?